Preimplantation interlead ECG heterogeneity is superior to QRS complex duration in predicting mechanical super-response in patients with non-left bundle branch block receiving cardiac resynchronization therapy.

Abstract

BACKGROUND:

Reliable quantitative preimplantation predictors of response to cardiac resynchronization therapy (CRT) are needed.

OBJECTIVE:

We tested the utility of preimplantation R-wave and T-wave heterogeneity (RWH and TWH, respectively) compared to standard QRS complex duration in identifying mechanical super-responders to CRT and mortality risk.

METHODS:

We analyzed resting 12-lead electrocardiographic recordings from all 155 patients who received CRT devices between 2006 and 2018 at our institution and met class I and IIA American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines with echocardiograms before and after implantation. Super-responders (n=35, 23%) had ≥20% increase in left ventricular ejection fraction and/or ≥20% decrease in left ventricular end-systolic diameter and were compared with non-super-responders (n=120, 77%), who did not meet these criteria. RWH and TWH were measured using second central moment analysis.

RESULTS:

Among patients with non-left bundle branch block (LBBB), preimplantation RWH was significantly lower in super-responders than in non-super-responders in 3 of 4 lead sets (P=.001 to P=.038) and TWH in 2 lead sets (both, P=.05), with the corresponding areas under the curve (RWH: 0.810-0.891, P<.001; TWH: 0.759-0.810, P≤.005). No differences were observed in the LBBB group. Preimplantation QRS complex duration also did not differ between super-responders and non-super-responders among patients with (P=.856) or without (P=.724) LBBB; the areas under the curve were nonsignificant (both, P=.69). RWHV1-3LILII ≥ 420 μV predicted 3-year all-cause mortality in the entire cohort (P=.037), with a hazard ratio of 7.440 (95% confidence interval 1.015-54.527; P=.048); QRS complex duration ≥ 150 ms did not predict mortality (P=.27).

CONCLUSION:

Preimplantation interlead electrocardiographic heterogeneity but not QRS complex duration predicts mechanical super-response to CRT in patients with non-LBBB.

• Authors: Alexandre L Bortolotto, Richard L Verrier, Bruce D Nearing, Alexandre A Marum, Bruna Araujo Silva, Giovanna C Pedreira, Fernanda Tessarolo Silva, Sofia A Medeiros, Jakub Sroubek, Peter J Zimetbaum, James D Chang
• Journal: Heart rhythm (Heart Rhythm) Vol. 17 Issue 11 Pg. 1887-1896 (11 2020) ISSN: 1556-3871 [Electronic] United States
• PMID: 32497764 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Bundle-Branch Block (physiopathology, therapy)
• Cardiac Resynchronization Therapy (methods)
• Electrocardiography
• Female
• Follow-Up Studies
• Heart Rate (physiology)
• Humans
• Male
• Retrospective Studies
• Stroke Volume (physiology)
• Ventricular Function, Left (physiology)